Integrating Care for Older People: New Care for Old, a Systems Approach

By Christopher Foote; Christine Stanners | Go to book overview

APPENDIX B
Other Models of Integrated Care

The USA

On Lok, San Francisco

In the USA an integrated care project called On Lok was started in San Francisco.

On Lok is an independent, community-based acute and long-term care scheme designed to meet the total, multiple and interrelated needs of very old, frail and disabled people. It started in 1973 and primarily serves the Chinese community, though members come from several ethnic groups. Over the years there have been many changes and developments, but essentially the service provides both medical and social care, enabling members to continue to live at home rather than going into hospital, nursing home or residential care. Members are in fact generally very disabled or in poor health, and in order to be eligible to join On Lok have to be assessed as needing the level of care provided in a nursing home.

On Lok’s focus is the Day Health Centre (a cross between a day hospital and day care centre), to which everyone goes as the mainstay of their care. This is also the base for the single transdisciplinary team (including doctors), though they also work in people’s own homes. The team assesses the needs of individuals for housing, home care, day care, hospital provision and medical treatment, and then provides that care. There are seven centres, some of which have supported housing schemes attached. Typically, each provides care for 100 older people, with about 60 people attending each day.


Program of All-inclusive Care for the Elderly (PACE)

This programme provides the basis for a series of replication projects, numbering about 20 fully accredited schemes throughout the US, with many more in the pipeline. Apart from the integrated system of care, the key factor about On Lok and PACE is that they are funded through a capitated budget obtained by combining Medicare and Medicaid payments. From this capitated fund, the organization is responsible for providing all the healthcare needs of its members (including nursing home care and hospital treatments). Since 1997 these payments have been incorporated into mainstream funding providing a secure funding regime for integrated care (previously the payments were specially negoti-

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